• Chenxi Hu, Steffen Huber, Syed R Latif, Guido Santacana-Laffitte, Hamid R Mojibian, Lauren A Baldassarre, and Dana C Peters.
• Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.
• J Magn Reson Imaging. 2018 Jun 1; 47 (6): 1498-1508.

BackgroundCardiac dark-blood turbo spin-echo (TSE) imaging is sensitive to through-plane motion, resulting in myocardial signal reduction.PurposeTo propose and validate reverse double inversion-recovery (RDIR)-a dark-blood preparation with improved motion robustness for the cardiac dark-blood TSE sequence.Study TypeProspective.PopulationHealthy volunteers (n = 10) and patients (n = 20).Field Strength1.5T (healthy volunteers) and 3T (patients).AssessmentCompared to double inversion recovery (DIR), RDIR swaps the two inversion pulses in time and places the slice-selective 180° in late-diastole of the previous cardiac cycle to minimize slice misregistration. RDIR and DIR were performed in the same left-ventricular basal short-axis slice. Healthy subjects were imaged with two preparation slice thicknesses, 110% and 200%, while patients were imaged using a 200% slice thickness only. Images were assessed quantitatively, by measuring the myocardial signal heterogeneity and the extent of dropout, and also qualitatively on a 5-point scale.Statistical TestsQuantitative and qualitative data were assessed with Student's t-test and Wilcoxon signed-rank test, respectively.ResultsIn healthy subjects, RDIR with 110% slice thickness significantly reduced signal heterogeneity in both the left ventricle (LV) and right ventricle (RV) (LV: P = 0.006, RV: P < 0.0001) and the extent of RV dropout (P < 0.0001), while RDIR with 200% slice thickness significantly reduced RV signal heterogeneity (P = 0.001) and the extent of RV dropout (P = 0.0002). In patients, RDIR significantly reduced RV myocardial signal heterogeneity (0.31 vs. 0.43; P = 0.003) and the extent of RV dropout (24% vs. 46%; P = 0.0005). LV signal heterogeneity exhibited a trend towards improvement with RDIR (0.12 vs. 0.16; P = 0.06). Qualitative evaluation showed a significant improvement of LV and RV visualization in RDIR compared to DIR (LV: P = 0.04, RV: P = 0.0007) and a significantly improved overall image quality (P = 0.03).Data ConclusionRDIR TSE is less sensitive to through-plane motion, potentiating increased clinical utility for black-blood TSE.Level Of Evidence1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:1498-1508.© 2017 International Society for Magnetic Resonance in Medicine.

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